The DSM-5's Proposed New Categories of Sexual Disorder: The Problem of False Positives in Sexual Diagnosis

The proposals that have emerged from the DSM-5 revision process have triggered considerable controversy, especially regarding potential invalid inflation of diagnostic categories. To illustrate the kinds of issues that have emerged, I closely examine the proposed new categories of sexual disorder. The DSM-5 Sexual and Gender Identity Disorders Work Group is proposing the addition of three categories of disorder to the DSM-5-hypersexuality, hebephilia (as part of a revised pedophilia category that would become pedohebephilia), and coercive paraphilic disorder (basically a "nonconsent" or rape paraphilia). These proposals are driven by perceived clinical or forensic needs. I argue, however, that their conceptual soundness remains problematic; each could lead to large numbers of false positive diagnoses (i. e., diagnoses that mistakenly label a normal variant of behavior as a mental disorder), with potential for serious forensic abuse in "sexually violent predator" civil commitment proceedings.